Iatrogenic arterial vasospasm during mechanical thrombectomy requiring treatment with intra‐arterial nimodipine might be associated with worse outcomes
Abstract
Background and Purpose Vasospasm is a common iatrogenic event during mechanical thrombectomy (MT). In such circumstances, intra‐arterial nimodipine administration is occasionally considered. However, its use in the treatment of iatrogenic vasospasm during MT has been poorly studied. We investigated the impact of iatrogenic vasospasm treated with intra‐arterial nimodipine on outcomes after MT for large vessel occlusion stroke. Methods We conducted a retrospective analysis of the multicenter observational registry Endovascular Treatment in Ischemic Stroke (ETIS). Consecutive patients treated with MT between January 2015 and December 2022 were included. Patients treated with medical treatment alone, without MT, were excluded. We also excluded patients who received another in situ vasodilator molecule during the procedure. Outcomes were compared according to the occurrence of cervical and/or intracranial arterial vasospasm requiring intraoperative use of in situ nimodipine based on operator's decision, using a propensity score approach. The primary outcome was a modified Rankin Scale (mRS) score of 0–2 at 90 days. Secondary outcomes included excellent outcome (mRS score 0–1), final recanalization, mortality, intracranial hemorrhage and procedural complications. Secondary analyses were performed according to the vasospasm location (intracranial or cervical). Results Among 13,678 patients in the registry during the study period, 434 received intra‐arterial nimodipine for the treatment of MT‐related vasospasm. In the main analysis, comparable odds of favorable outcome were observed, whereas excellent outcome was significantly less frequent in the group with vasospasm requiring nimodipine (adjusted odds ratio [aOR] 0.78, 95% confidence interval [CI] 0.63–0.97). Perfect recanalization, defined as a final modified Thrombolysis In Cerebral Infarction score of 3 (aOR 0.63, 95% CI 0.42–0.93), was also rarer in the vasospasm group. Intracranial vasospasm treated with nimodipine was significantly associated with worse clinical outcome (aOR 0.64, 95% CI 0.45–0.92), in contrast to the cervical location (aOR 1.37, 95% CI 0.54–3.08). Conclusion Arterial vasospasm occurring during the MT procedure and requiring intra‐arterial nimodipine administration was associated with worse outcomes, especially in case of intracranial vasospasm. Although this study cannot formally differentiate whether the negative consequences were due to the vasospasm itself, or nimodipine administration or both, there might be an important signal toward a substantial clinical impact of iatrogenic vasospasm during MT.
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BibTeX
@article{ferhat2026iatrogenic,
title = {{Iatrogenic arterial vasospasm during mechanical thrombectomy requiring treatment with intra‐arterial nimodipine might be associated with worse outcomes}},
author = {Serine Ferhat and Guillaume Bellanger and Malgorzata Milnerowicz and Maeva Kyheng and Julien Labreuche and Igor Sibon and Mehdi Khobzi and Joe‐marie Abousleiman and Dan‐adrian Popica and Solene Moulin and Cyril Dargazanli and Arturo Consoli and Omer Eker and Louis Veunac and Kevin Premat and Benjamin Gory and Jean‐christophe Gentric and Ricardo Moreno and Wagih Ben Hassen and Maxime Gauberti and Raoul Pop and Aymeric Rouchaud and Romain Bourcier and Bertrand Lapergue and Gaultier Marnat},
journal = {European Journal of Neurology},
year = {2026},
month = oct,
doi = {10.1111/ene.16467},
url = {https://hal.science/hal-04694225v1},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Iatrogenic arterial vasospasm during mechanical thrombectomy requiring treatment with intra‐arterial nimodipine might be associated with worse outcomes
AU - Serine Ferhat
AU - Guillaume Bellanger
AU - Malgorzata Milnerowicz
AU - Maeva Kyheng
AU - Julien Labreuche
AU - Igor Sibon
AU - Mehdi Khobzi
AU - Joe‐marie Abousleiman
AU - Dan‐adrian Popica
AU - Solene Moulin
AU - Cyril Dargazanli
AU - Arturo Consoli
AU - Omer Eker
AU - Louis Veunac
AU - Kevin Premat
AU - Benjamin Gory
AU - Jean‐christophe Gentric
AU - Ricardo Moreno
AU - Wagih Ben Hassen
AU - Maxime Gauberti
AU - Raoul Pop
AU - Aymeric Rouchaud
AU - Romain Bourcier
AU - Bertrand Lapergue
AU - Gaultier Marnat
PY - 2026
DA - 2026/10/07
JO - European Journal of Neurology
DO - 10.1111/ene.16467
UR - https://hal.science/hal-04694225v1
AB - Background and Purpose Vasospasm is a common iatrogenic event during mechanical thrombectomy (MT). In such circumstances, intra‐arterial nimodipine administration is occasionally considered. However, its use in the treatment of iatrogenic vasospasm during MT has been poorly studied. We investigated the impact of iatrogenic vasospasm treated with intra‐arterial nimodipine on outcomes after MT for large vessel occlusion stroke. Methods We conducted a retrospective analysis of the multicenter observational registry Endovascular Treatment in Ischemic Stroke (ETIS). Consecutive patients treated with MT between January 2015 and December 2022 were included. Patients treated with medical treatment alone, without MT, were excluded. We also excluded patients who received another in situ vasodilator molecule during the procedure. Outcomes were compared according to the occurrence of cervical and/or intracranial arterial vasospasm requiring intraoperative use of in situ nimodipine based on operator's decision, using a propensity score approach. The primary outcome was a modified Rankin Scale (mRS) score of 0–2 at 90 days. Secondary outcomes included excellent outcome (mRS score 0–1), final recanalization, mortality, intracranial hemorrhage and procedural complications. Secondary analyses were performed according to the vasospasm location (intracranial or cervical). Results Among 13,678 patients in the registry during the study period, 434 received intra‐arterial nimodipine for the treatment of MT‐related vasospasm. In the main analysis, comparable odds of favorable outcome were observed, whereas excellent outcome was significantly less frequent in the group with vasospasm requiring nimodipine (adjusted odds ratio [aOR] 0.78, 95% confidence interval [CI] 0.63–0.97). Perfect recanalization, defined as a final modified Thrombolysis In Cerebral Infarction score of 3 (aOR 0.63, 95% CI 0.42–0.93), was also rarer in the vasospasm group. Intracranial vasospasm treated with nimodipine was significantly associated with worse clinical outcome (aOR 0.64, 95% CI 0.45–0.92), in contrast to the cervical location (aOR 1.37, 95% CI 0.54–3.08). Conclusion Arterial vasospasm occurring during the MT procedure and requiring intra‐arterial nimodipine administration was associated with worse outcomes, especially in case of intracranial vasospasm. Although this study cannot formally differentiate whether the negative consequences were due to the vasospasm itself, or nimodipine administration or both, there might be an important signal toward a substantial clinical impact of iatrogenic vasospasm during MT.
SN - 1351-5101
SN - 1468-1331
ER -